促性激素释放激素类似物治疗子宫内膜异位症副作用的临床观察

Clinical observation on side effects of GnRH-a in treatment of endometriosis

目的探讨子宫内膜异位症术后应用促性激素释放激素类似物(GnRH-a)治疗的副作用。方法收集34例确诊为Ⅲ-Ⅳ期的子宫内膜异位症患者;术后第3天给予GnRH-a(戈舍瑞林)3.6 mg/28 d,共6次。第2次用药时,当E2<5 pg/ml或出现潮热出汗等症状时给予反向添加戊酸雌二醇0.5-1 mg/d至疗程结束。监测患者性激素(FSH、LH、E2)水平、腰椎骨密度及骨生化代谢指标(血钙、血磷),比较反向添加后性激素水平及骨质变化情况;观察GnRH-a引起的不良反应及反向添加后改善情况、月经恢复时间及妊娠情况。结果第1次用药后潮热出汗症状即出现,其他低雌激素症状第2次用药后表现明显;反向添加后潮热出汗症状缓解明显,而阴道干燥、骨痛等症状无明显缓解;雌激素水平于用药4周时达绝经期水平,停用GnRH-a 3个月内月经复潮;治疗后20周骨密度与治疗前相比,差异有统计学意义(P<0.05)。结论应用GnRH-a后导致的副作用存在明显的个体差异,常规反向添加并不能缓解患者所有不良反应,建议对患者的治疗个体化,对于阴道出血时间长者可增加GnRH-a剂量,而副作用显著者可适时减低GnRHa-a剂量。

Objective To observe the side effects of GnRH-a for endometriosis after surgery. Methods Thirty-four patients diagnosed as moderate or severe endometriosis,were given goserelin（3.6 mg every 28 days）for total six times from the 3rd day after the operation.Estradiol valerate 0.5-1 mg/d was given as add-back therapy until the end of treatment when E25 pg/ml or hot flashes and sweating symptoms appeared at the second time of medication.The levels of follicle-stimulating hormone（FSH）,E2,luteinizing hormone（LH）,bone mineral density of the lumbar spine（L-BMD） and bone metabolic biochemical markers（serum calcium and phosphorus）were detected.The levels of sex hormone and bone losses were compared after the add-back therapy.The incidences of side effects and improvement after add-back therapy,the duration of restoration of menstruation and gestation circs were observed. Results Hot flash,sweating symptoms appeared after the first medication,and the other low-estrogenic symptoms were more obvious after the second medication.Hot flash and sweating symptoms were improved after the add-back therapy,while there was no significant relief on vaginal dryness and bone pain.Estrogen level reached the level at menopause after four-week medication.The menstruation restored within 3 months after stopping the GnRH-a treatment.BMD was significantly decreased at 20 week after treatment（P0.05）. Conclusion The side effects caused by GnRH-a therapy are significantly individualized.The routine add-back therapy could not release all the symptoms among the patients.The patients should be given the individual treatment.The dosage of GnRH-a could be increased in patients suffering from persistent vaginal bleeding,while reduced in patients with severe side effects.